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How to Get the Most Out of Obamacare

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By Napala Pratini, The Fiscal Times

February 24, 2014

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If you’re among the more than 3 million Americans who have enrolled for Obamacare, here’s what you need to know about your health care plan. First, make sure you’ve paid your premium—signing up doesn’t mean you have coverage.

Coverage doesn’t kick in immediately. If you signed up between the 1st and 15th of the month, your coverage begins on the first day of the next month. If you enrolled between the 16th and the last day of the month, your coverage begins on the first day of the second following month.

For example, if you enrolled on February 10, your coverage will begin on March 1, but if you enrolled on February 20, your coverage will not begin until April 1.

You’ll want to stay in-network. You can find a provider directory on your insurer’s website. An easy way to find the provider directory specific to your plan is to use HealthCare.gov’s shopping tool. Search for your location and your plan, then click on “Details” for a link to “Provider Directory.”

Unfortunately, many top hospitals have begun to opt out of insurance plans under the ACA. U.S. News has published a list of top hospitals and the insurance plans they accept. Check with local hospitals and your insurer before getting treated at a hospital for a planned procedure.

Tap all of your ‘essential benefits.’ All health plans under the ACA are required to offer essential health benefits such as doctor visits, prescription drug coverage, hospitalization and maternity care. However, you might not realize that all health insurance plans under the ACA marketplace must also cover a list of preventive services at no cost.

For adults, free preventive services include blood pressure screening, diet counseling for adults at higher risk for chronic disease, HIV screening, immunization vaccines for adults such as the flu shot, syphilis screening for all adults at higher risk, and depression screenings. Women get additional benefits, including prenatal and pregnancy services, mammography screenings, and domestic violence counseling.

Children also have access to a number of free preventive services, including autism screening, behavioral assessments, and immunization vaccines.

Stay on top of your costs. Ideally you’ll have calculated the cost of your health insurance before purchasing a plan, but it’s worth running through the numbers again once the bills start coming due to look for ways to trim expenses.

It’s nearly impossible to know just how much you’ll spend on medical costs each year, but you should still try to estimate it for budgeting purposes. The one cost you can count on is your monthly premium, which is unlikely to change, as there are only specific instances under which you’ll be able to change your plan.

Next, understand your deductible. If your deductible is $6,000 a year, you will pay $6,000 out of pocket before your health insurance begins to pay your medical expenses.

Be aware there may be certain health care services not covered by your insurance plan – so you’ll have to pay for them even after exceeding the deductible. However, the ACA mandates that many services be covered from now on, including pregnancy and mental health services.

While you can’t predict emergencies, it’s still smart to set aside enough money to cover your expenses up to your deductible, should something unexpected arise.

In addition to copays and services, you’ll want to factor in your estimated prescription drug expenses. The ACA requires plans to cover prescription drugs, but the company gets to choose which drugs are covered. Contact your insurer to see what those drugs are and what your prescriptions will cost. Finally, consider any planned expenditures, such as having a baby or undergoing a hip replacement. The costs of giving birth or having surgery can add up, so be sure to budget that into your year.

If you’ve set up a health savings account (HSA), you should be sure to know exactly what can be purchased with the account. The IRS dictates that an HSA account can be used to pay for “qualified medical expenses,” including things like ambulance services, doctors’ fees, prescription medication costs, laboratory fees, chiropractors, dental treatment, and drug addiction treatment. Expenses not eligible for reimbursement include cosmetic surgery, funeral services, and most over-the-counter drugs.

Revisit your subsidy settings. Nearly 80 percent of people who have purchased plans on the public exchanges are eligible for a subsidy, according to the Department of Health and Human Services. When you enrolled in a plan, you were required to estimate your 2014 income in order to determine whether you’d receive a subsidy. You were also given the choice to have the subsidy paid directly to the insurers or to pay your premiums in entirety and claim the credit on your 2014 taxes.

When you do your taxes next year, you’ll need to reconcile the estimated amount with the actual amount you earned. If you received too high a subsidy, you’ll owe the difference to the IRS. To avoid a huge cut to your tax return, revisit your subsidy settings mid-year to make sure your actual income is shaping up in line with your estimate.